Ischaemic colitis during interferon treatment for chronic hepatitis C: report of two cases and literature review

Abstract

Ischaemic colitis is known to be a severe emergency complication of interferon (IFN) therapy. However, as ischaemic colitis is an infrequent complication of IFN therapy, limited information is available regarding the safety of resuming IFN therapy after resolution of ischaemic colitis and subsequent recurrence. Here, we report two cases of ischaemic colitis during IFN therapy for chronic hepatitis C. Ischaemic colitis was fully healed within 1 week after its onset and IFN withdrawal, and IFN therapy was resumed following patients' wishes to do so. Ischaemic colitis did not recur after the resumption of IFN therapy, and sustained virological response was achieved in both patients. In this report, we also summarize the findings of 11 cases of IFN-associated ischaemic colitis (nine previously published cases plus our two cases) and review the clinical characteristics of ischaemic colitis during IFN therapy in patients with chronic hepatitis C.

Ischemic Colitis with Type I Interferons Used in the Treatment of Hepatitis C and Multiple Sclerosis: An Evaluation from the Food and Drug Administration Adverse Event Reporting System and Review of the Literature

“…IFN-α has been suspected to induce IC in 11 published case reports. 14 Possible mechanisms of action have been proposed, including gastrointestinal vasculitis secondary to the immune-modulating effects of interferon; vasculitis is a known cause of IC. Interferons have also been suspected to cause a direct vasospastic effect that leads to a decrease in blood flow, possibly resulting in a lack of blood flow to the colon.…”

“…Interferons have also been suspected to cause a direct vasospastic effect that leads to a decrease in blood flow, possibly resulting in a lack of blood flow to the colon. 14 Although rare, hypotension is a known adverse effect of interferon treatment in addition to being a known risk factor for IC. 29 It is foreseeable that one or more of these factors could have led to IC with the use of either type I interferon.…”

“…8 In published case reports, IFN-α has been suspected to induce IC, with an average time of onset of 20.1 weeks. 14 The incidence of IC with IFN-α varies between 0.2% and 14.3%, 15-17 while the incidence rate of IC with IFNβ is unknown. However, an association between type I interferons and IC has not been evaluated using a pharmacovigilance database.…”

Thrombosis Associated with Viral Hepatitis

“… 61 – 68 The pathophysiology of interferon-related ischemic colitis is not clear. Possible mechanisms of action are the following: gastrointestinal vasculitis secondary to the immune-modulating effects of interferon, a direct vasospastic effect by interferon leading to a decrease in blood flow to the colon, 67 or hypotension, a known rare adverse effect of interferon treatment. 69 …”

Ischaemic colitis during pegylated interferon-alpha monotherapy for chronic hepatitis B: A case report

“…[ 1 ] In published case reports, interferon-alpha has been suspected of inducing IC. [ 2 ] Estimates of the incidence of IC associated with interferon-alpha (IFN-α) treatment vary from 0.3% to 0.7%, and it is most often seen in patients with chronic viral hepatitis C and multiple sclerosis. [ 3 ] IFN-α is widely used to treat hepatitis B virus (HBV) infection, but no case of IC associated with interferon (IFN) treatment for chronic hepatitis B has ever been reported.…”